Application of the theory of planned behavior to oral anticoagulant therapy.

Anticoagulation control is imperative for individuals who are prescribed long-term oral anticoagulation therapy. Therapeutic international normalized ratios decrease the risk of the thromboembolic complications that are associated with oral anticoagulation therapy. Individuals on oral anticoagulation therapy are often asked to make lifestyle modifications that can become barriers to medication adherence. The application of the theory of planned behavior to oral anticoagulation therapy can be used to assist advanced practice nurses in assessing individuals for the perceived barriers or obstacles that might interfere with the behavioral changes necessary to successfully comply with the recommended treatment plan.

Nursing Guide to Management of Major Symptoms in Patients with Malignant Glioma.

OBJECTIVES: To provide an overview of the symptoms commonly experienced by patients with malignant glioma, and discuss the pathophysiology and interventions associated with those. DATA SOURCES: A review of published scientific literature and clinical literature, and online information from National Comprehensive Cancer Network, Oncology Nursing Society, Epilepsy Foundation of America, and the American Brain Tumor Association. CONCLUSION: The unique symptom burden associated with a malignant glioma diagnosis often disrupts the lives of patients and their caregivers. Clinical support and interventions addressing malignant glioma-related focal deficits, seizures, headaches, venous thromboembolism, mood disturbances, fatigue, and sleep-wake disturbance can positively impact patient and caregiver experiences while living with malignant glioma. IMPLICATIONS FOR NURSING PRACTICE: Understanding the pathophysiology of these symptoms and reviewing nursing-led and supported interventions will empower the nurse in providing comprehensive care to patients with malignant glioma and their caregivers.

The assessment and management of venous thromboembolism.

This article examines venous thromboembolism (VTE) and offers guidance on its prevention. VTE is a potentially fatal condition, which can be prevented using both pharmacological and mechanical methods. Nursing staff should be aware of the risk factors that predispose patients to venous thromboembolism and ensure that high-risk patients receive the prophylaxis they require.

CE: Atrial Fibrillation: Updated Management Guidelines and Nursing Implications.

OVERVIEW: Atrial fibrillation, the most common chronic cardiac arrhythmia, adversely affects the quality of life of millions of people. The condition is frequently associated with advancing age, structural cardiac dysfunction, and preexisting comorbidities. The most common complications, stroke and heart failure, result in significant morbidity and mortality. Indeed, atrial fibrillation is responsible for over 450,000 hospitalizations and 99,000 deaths annually and adds up to $26 billion to U.S. health care costs each year. Given the aging of the U.S. population, the incidence of atrial fibrillation is expected to double within the next 50 years. There is evidence that nursing intervention in patient education and transition of care coordination can improve adherence to treatment plans and patient outcomes.This article reviews the recently updated guideline for the management of atrial fibrillation, issued jointly by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society. It focuses on the prevention of thromboembolism and on symptom control, and stresses the importance of patient adherence to treatment plans in order to ensure better outcomes.

Low molecular weight heparins in special populations.

Low molecular weight heparins (LMWH) are replacing unfractionated heparin (UH) as safe and effective agents for the prevention and treatment of thromboembolism. Although LMWH offer many advantages over UH, usage is less clearly defined in certain special populations, including renal dysfunction, obesity and pregnancy. This article will briefly review the pharmacology of LMWH and discuss usage in these special populations.

Venous thromboembolism in patients with cancer. Part I. Survey of oncology nurses' attitudes and treatment practices for ambulatory settings.

Patients with cancer have a higher incidence of venous thromboembolism (VTE). Little information currently exists on VTE and the understanding and beliefs of oncology nurses. Therefore, the attitudes and treatment practices of ambulatory oncology nurses were surveyed to determine the current knowledge base of VTE in patients with cancer. Survey results are presented along with a thorough literature review of thromboembolism and the unique risk factors for this frequent complication in patients with cancer. The causes of VTE in this patient population often are multifactorial and include hypercoagulability, stasis, and vascular endothelial damage from procedures or the neoplastic process itself. In particular, chemotherapy administration can increase the risk of thrombosis considerably. New therapies, including thalidomide, require oncology nurses caring for these patients to have heightened awareness of the potential for thrombogenic complications. This is the first of two articles that address the problem of thromboembolism in patients with cancer, including the survey results. (See part II on page 465.) Oncology nurses are essential in the care of VTE in patients with cancer and can help with patient identification, treatment, and compliance for improved patient outcomes.

Factor V Leiden mutation in pregnancy.

Normal maternal adaptation to pregnancy significantly increases the risk for thrombus formation. Inherited thrombophilias further increase risk for deep venous thrombosis and adverse outcome in pregnancy. Factor V Leiden mutation is the most common inherited thrombophilia, occurring in approximately 5% of the White and 1% of the Black populations. Nurses should be knowledgeable about screening for and diagnosis of factor V Leiden mutation, risk reduction counseling, recommended care of the affected patient, and implications of anticoagulant therapy during the perinatal period.

Thromboembolic disorders in cancer.

Complex factors, including substances in cancer cells, cancer treatment effects, and venous stasis associated with chronic illness, blood vessel wall injury, and immobility, interact to place patients with cancer at risk for thrombosis. This article describes the etiology, clinical manifestations, diagnostic tests, and treatments for venous and pulmonary emboli associated with cancer. It explores the nurse's role in assessing patients who are at risk, managing symptomatic thrombosis and primary and secondary prevention of emboli, and administering anticoagulant therapy. As growing numbers of patients are treated in outpatient settings, oncology nurses play a critical role in the coordination of care for patients at risk for thrombosis. A nursing care plan summarizes key nursing strategies for assessment and intervention.

Prophylaxis for thromboembolism in elective orthopaedic surgery.

Thromboembolism is a major complication for patients undergoing elective hip and knee surgery. It can delay full recovery and increase the cost of treatment. This review article focuses on the pathophysiology, risk factors, and methods of prophylaxis in this select patient group. Emphasis is placed on the role of the nurse in the ongoing assessment of the patient's risk for thromboembolism.

Orthopedic complications. Compartment syndrome, fat embolism syndrome, and venous thromboembolism.

Specialized education in the care of orthopedic patients includes an understanding of the common complications for which patients require monitoring. With a socioeconomic backdrop of decreasing hospital stays and prospective payment, patient care must be managed proactively. For all three complications presented, there are unique sets of risk factors that, when present, contribute to a high index of suspicion for morbidity. Clusters of symptoms have also been discussed representing the expected normal patterns. With this knowledge as a foundation, clinical application is essential to incorporate other salient aspects of individual situations. Nurses diagnose and treat human responses to health problems. The end result of human responses to injury or orthopedic conditions can be the development of complications. Stringent adherence to patient monitoring protocols can promote timely nursing interventions to prevent, minimize, or detect complications or treatment side effects. Although definitive treatment is often physician directed, nurses are in a key role to impact final patient outcomes.

Factor V Leiden mutation: a nursing perspective.

The factor V Leiden mutation is a recently described autosomal dominant genetic risk factor for venous thromboembolism (VTE). Persons who are heterozygous or homozygous for this disorder are at 4 to 7 times and 50 to 100 times increased risk, respectively, for VTE. In particular, women have unique challenges because the presence of the Leiden mutation in combination with pregnancy or use of oral contraceptives results in an even greater increased risk for VTE. This article will review the factor V Leiden mutation, its association with VTE, and the genetic inheritance pattern and ethnic distribution. Oral contraceptive use, pregnancy, and hormone replacement therapy in women with the Leiden mutation will be discussed. Screening issues and management for all patients, and women in particular, will be addressed. Nursing implications for care management of this group of patients is complex and requires evaluation of the significance of newly defined genetic disorders such as the factor V Leiden mutation. Nurses need to be knowledgeable about genetic screening, risk factors, risk-reduction counseling, and considerations for long-term therapy, which include quality of life issues. Two case studies exemplify many of the issues that will be discussed.

Venous thromboprophylaxis in acutely ill patients: nursing role.

Venous thromboembolism (VTE) is a serious medical problem and is one of the most important preventable causes of mortality and morbidity in hospitalized patients. This article reviews the prevention of VTE with thromboprophylaxis in acutely ill general medical patients. We review recent studies which show that general medical patients are at moderate risk of VTE and that low-molecular-weight heparin reduces this risk. Nurses have a key role to play in changing clinical practice by increasing awareness of the risk of VTE in medical patients, helping in the process of risk assessment and ensuring appropriate prophylaxis.

Anticoagulation therapy: patient management and evaluation of an outpatient clinic.

Health practitioners in the primary care setting often assess and manage patients on warfarin therapy. This article discusses new trends in oral anticoagulation and the latest indications for warfarin use. Patient management and education guidelines to improve patient care and compliance with warfarin therapy are reviewed. Results of a 19-month evaluative, retrospective, descriptive study of a nurse practitioner-run clinic are summarized. The results support that anticoagulation clinics managed by nurse practitioners are safe and effective.

Venous thromboembolism: prevention & treatment.

Venous thromboembolism still threatens the lives of hundreds of thousands of people in the United States--and some of them are your patients. Here's how to put the latest research and technology to good use in the fight against thromboembolic disease.